PROJECT SUMMARY There is a fundamental gap in how the presence of family companions in medical visits influences indicators of quality of care, such as patient-centered communication (e.g., communication that reflects respect for patients' values and incorporates patient's concerns and preferences into decision-making), specifically for patients with heart failure - a particularly vulnerable population by virtue of its high morbidity and mortality. The long-term goals of this project are to improve the quality and delivery of care and subsequent health outcomes for Heart Failure (HF patients). The overall objective here, which is our next step in pursuit of our long-term goal, is to determine whether family accompaniment influences processes of care within the medical visit and use this information to inform intervention development. The rationale for the proposed research is that once we know how family members influence quality and delivery of care we can fulfill the call to action of policy makers and health care models to create an integrated, coherent plan for ongoing medical care in partnership with patients and their families. The research strategy is built around the central hypothesis that involvement of family members in clinical care will facilitate patient-provider communication and potentially improve subsequent HF self-management behaviors. The specific aims to achieve our overall objective are: 1) To investigate the impact of family companion's presence on patient centered communication as assessed by the following audio-tape measures: the patient-centeredness ratio (ratio of communication that furthers the patient's agenda to communication that furthers the provider's agenda), patient activation and engagement behaviors, and physician facilitation and patient activation behaviors; 2) To assess the impact of family companion's presence on provider communication related to patient education and counseling about HF self-management behaviors (e.g., weighing, diet, symptom management, physical activity, and medication adherence); and 3) To use intervention mapping (IM) to design a family-involved HF intervention based on qualitative data and results of Aims 1 and 2, and pre-test the intervention. The mentored research, formal didactics, and planned presentations/publications will set the stage for independent funding as a clinician-scientist.